1. Field Of The Invention
The present invention relates to a surgical kit for treating urinary incontinence in a man, to the use of such a kit, and to a surgical method of treating urinary incontinence in a man by means of the kit. The invention also relates to a strip for supporting the urethra of a man in order to treat incontinence.
Urinary incontinence in man after prostatectomy is a debilitating condition that reduces quality of life, even when incontinence is moderate. The number of incontinent patients has increased in the last few years with the advent of facilities for early detection of cancer of the prostate and with a greater number of total prostatectomies being performed. Even though recent operative techniques make it possible to preserve the sphincter better, leaks of urine can occur in a non-negligible percentage of cases: these leaks of urine are associated with the surgical technique which sections the low portion of the prostate in the immediate vicinity of the sphincter, but they can also be encouraged by elements particular to the patient, such as a short urethra, a weak or easily-tired sphincter, etc.
For patients suffering from urinary incontinence in spite of retraining of their sphincter, the surgical treatment that has commonly been employed in the last few years consists in implanting an artificial sphincter. This surgery significantly limits incontinence, but it suffers from major drawbacks: the patient must manipulate a pump on each miction, the implanted equipment is onerous, and the repeat surgery rate is high.
A novel surgical treatment technique has thus appeared in the last few years, namely installing a supporting implant under the urethra, the implant generally being in the form of a plate-shaped net. That kind of net needs to be firmly secured to the anatomical structures of the patient in order to guarantee effective support of the urethra and thus correct incontinence.
2. Brief Description Of The Related Art The plate is thus either suspended by threads rising on either side of the bladder over or behind the pubic bone, with terminal fastenings in the patient's abdominal wall, or else they are secured directly by screws placed in the bony ischio-pubic branches of the patient. The first configuration leads to real risks of perforating the bladder, and the second configuration, comprising surgery that is more complex, exposes the patient to risks of ostitis. In both configurations, the presence of an implanted plate can lead to postoperative perineal discomfort that is transient or to perineal pain that is permanent. Furthermore, even if the success rate of the treatment is high in the short term, it tends to drop significantly over time.
Simultaneously, the equipment and methods used for surgical treatment of incontinence in women have been successively developed over the last few years. In particular, EP-A-1 342 450 in the name of the present Applicant discloses a strip for sub-urethral support that can be implanted, amongst other approaches, by a so-called “transobturator” approach, i.e. by passing the free end portions of the strip through the respective obturator foramens of the pelvic bone of a patient, thus having the effect of suspending the urethra by means of the longitudinal middle portion of the strip. The advantages of this transobturator approach for implantation are real, since they run no risk of perforating the bladder and they do not require any fastening to bone, with only the free ends of the strip being secured to the abdomen of the patient.